I was a 23-year-old intensive care unit nurse when the US Supreme Court's
Roe v. Wade
decision shockingly declared abortion legal. Nearly 40 years later I am still an ICU nurse, as the Patient Protection and Affordable Care Act (also known as the ACA, popularly known as Obamacare) has been shockingly declared legal as a tax by the Supreme Court.

The first Supreme Court decision ushered in the Culture of Death. Will the second decision establish it as a right?

The past as prologue

In 1973, the public was told that the
Roe v. Wade
decision just made abortion legal for the first three months of pregnancy and would save thousands of lives of women who foolishly but desperately sought out so-called back alley abortionists. The doctors and nurses I worked beside were surprised but hoped for the best. We were told that once abortion was out in the open, it would become easier to help these women have their babies. Abortion would only be a last resort. The real consequences came later.

Now we have Planned Parenthood clinics operating as politically correct abortion businesses, subsidized by hundreds of millions of taxpayer dollars every year. Articles about women seriously harmed or even dying from legal abortions rarely make even the local news.

Conscience rights for health care providers and religious organizations are being dismantled, most recently by the Obama administration's Health and Human Services department mandating so-called free birth control including contraceptives, sterilizations, and abortifacients as "essential preventive health care" regardless of religious, moral, or even medical objections.

Reasoned dissent from the expanding abortion agenda is increasingly marginalized as "extremist" and an unconstitutional intrusion of religion. In 1973, such developments were unthinkable but if fertility and babies can now be characterized as "diseases" to be prevented, what can we expect regarding people with chronic illnesses, disabilities, old age, etc. following this latest Supreme Court ruling?

The Affordable Care Act

During the 2010 battle to pass the Affordable Care Act, House speaker Nancy Pelosi (D-CA) made the notorious comment "We have to pass the bill so that you can find out what is in it."

However, one of the biggest dangers may not lie in what the bill specifically states but rather its mechanism for setting up an unelected but powerful panel called the Independent Payment Advisory Board (IPAB), which, along with the existing United States Preventive Services Task Force and other government agencies, will strongly determine how health care will be distributed. But even before this latest panel takes effect, we are already beginning to see the effects of a utilitarian economic mindset on healthcare. "Living wills" and other advance directives are increasingly promoted as an effective way to reduce Medicare costs at the end of life. The impact of these panels and agencies will be enormous if and when the ACA takes full effect.

Nursing Economic$

Nursing is often cited the most trusted profession, even above doctors. I believe that this is due, at least in part, to the fact that we are not paid by the amount of care provided nor do we command enviable salaries. Traditionally, we are advocates for the individual patient regardless of age, socioeconomic status, etc. But with such great trust comes great responsibility. Whether or not we deserve this as nurses depends in large part on our education and motivation. Unfortunately, both are at greater risk than ever now as educational, legal, and cultural influences are undermining a profession of caring.

Recently, I had a startling glimpse into the possible future nightmare facing both healthcare and nursing when I read "How Can We Afford to Die?" the May-June 2012 issue of
Nursing Economic$. (No, the "$" is not a typo but evidently a mindset.)

This influential nursing journal, written by nurse educators and others in health care policy positions, devoted the whole issue to death, dying, and cost containment. The agenda quickly became clear as the costs at the end of life were endlessly cited, but concerns about potential abuses were dismissed and conscience rights were not even mentioned in the six articles I read.

Note these quotes from an articled titled "End of Life Care in the United States: Current Reality and Future Promise": "Health care professionals have an ethical responsibility to assist patients to achieve the care and life they want for their last days, and
in many cases that may involve assisting them to die with dignity in a surrounding of their choice, and embraced by those they have loved for a life-time" (emphasis added); and from the conclusion "Simply put, we can begin
to control the cost of end-of-life care and afford to die with dignity
if we act today" (emphasis added).[1]

In another article titled "Quality in Life and Death: Can We Have the Conversations?", Deborah B. Gardner PhD, RN enthusiastically cites polls purporting to show overwhelming public support for physician-assisted suicide and euthanasia, while apparently bemoaning a poll showing a majority of physicians against this. She dismisses the idea of a "slippery slope" with legalized euthanasia but ironically states that "To offer assisted dying effectively,
it must be integrated into the practice of medicine" (emphasis added). Also disturbing in light of the Supreme Court decision, she also states that "As nurses, we participate in providing
social justice through the delivery of health care" (emphasis added).[2]

In the editorial for this issue of
Nursing Economic$, Donna M. Nickitas, PhD, RN says that "Nurses are well positioned to advocate for death with dignity" and unapologetically even advocates for "punitive reimbursement policies for excessive end-of-life treatments that only prolong life."3 If enacted, such penalties will certainly intimidate many doctors regarding how aggressively to treat you if you are terminally ill, elderly, critically or chronically ill, or even potentially disabled.

This issue of
Nursing Economic$
was given in conjunction with the Hospice-Palliative Care Action Plan presented at the Fifth
Nursing Economic$
Summit "How Can We Afford to Die?" on June 6, 2012 in Washington, DC, in which an 8-point action plan was also presented. One of the points discussed the importance of getting everyone over the age of 18 to sign "living wills" and other advance directives. But this point had one interesting caveat: "if many patients have
advance directives that make positive, cost-conscious systemic change impossible, most of the other efforts discussed as part of our action plan will go for naught"[4] (emphasis added).

In other words,
not
choosing a potentially premature death can upset the economic imperative to reduce costs.

Loss of Ethics and Conscience Rights

We are fast losing two of the most effective protections against an economics-obsessed, utilitarian health care system: traditional ethics and conscience rights. Without these two bulwarks, laws and regulations tend to follow the latest bias, pressure group, or opinion poll and ignore such basic human rights as life, religion, and freedom of speech.

When assisted suicide promoter Dr. Timothy Quill can become director of the American Academy of Hospice and Palliative Medicine[5] - and our own United States government can by decree force Catholic institutions and other moral objectors to suddenly cover abortifacients and sterilizations - we must realize that we are already far down the road to an enforced Culture of Death that recognizes no bedrock principles or, in the end, even choice.

[5] Board of Directors AAHPM. Online:
aahpm.org/about/default/board.html. Note that Dr. Quill is identified as a Death with Dignity National Center Board Member. Although unmentioned, Dr. Quill was also the respondent in the 1997 US Supreme Court case Vacco v. Quill challenging the ban on assisted suicide in New York, arguing that there is no difference between refusing lifesaving medical treatment and assisted suicide. The court ruled unanimously that there was no constitutional right to assisted suicide. Full disclosure: I was personally involved in writing the amicus brief for the National Association of Pro Life Nurses (nursesforlife.org) in this case.

Nancy Valko, a registered nurse from St. Louis, is president of Missouri Nurses for Life, a spokesperson for the National Association of Pro Life Nurses, and a Voices contributing editor.